Organization
WHEATON ORTHOPAEDICS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAMIE T. MARTIN (BUSINESS OFFICE MANAGER)
(630) 665-9155
Entity
Organization
Contact information
Practice address
327 GUNDERSEN DR, STE A, CAROL STREAM, IL 60188-2402
(630) 665-9155
(630) 665-5557
Mailing address
327 GUNDERSEN DR, STE A, CAROL STREAM, IL 60188-2402
(630) 665-9155
(630) 665-5557
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
42001705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130944200
US DEPT LABOR
IL
01
—
2215428
BLUESHIELD PROVIDER NO
IL
01
—
6017960001
NSC
IL
01
—
CM4157
RAILROAD MEDICARE PROV NO
IL
Enumeration date
08/02/2005
Last updated
01/28/2009
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